Provider Demographics
NPI:1417025487
Name:WOLFSON, CHARLES D (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HOPKINTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2103
Mailing Address - Country:US
Mailing Address - Phone:508-366-5909
Mailing Address - Fax:508-366-5909
Practice Address - Street 1:43 HOPKINTON RD
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2103
Practice Address - Country:US
Practice Address - Phone:508-366-5909
Practice Address - Fax:508-366-5909
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3234103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0514101Medicaid
W03359OtherBLUE CROSS BLUE SHIELD MA
MA1010340OtherBEACON HEALTH STRATEGIES
W03359OtherBLUE CROSS BLUE SHIELD MA